Nursing - Theses
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ItemExamining healthcare professionals’ communication across the perioperative pathway to improve patient safety( 2012)Background: Communication practices of healthcare professionals have been strongly implicated in the cascade of events that unfold into poor outcomes for surgical patients. Many local and international reports consistently implicate the perioperative environment and communication failure, as critical constituents in the generation of serious adverse events. However, research is lacking into how communication failure occurs and how healthcare professionals achieve communication successes, across all domains of the perioperative pathway, which includes preoperative, intraoperative and postoperative domains. Aims: The aims of this thesis are to explore healthcare professionals’ communication patterns and failures, and describe the impact of communication failures on clinical practice and patient care across the perioperative pathway. Additionally, this thesis aims to provide understandings of how healthcare professionals overcome communication failures and bridge communication gaps across the perioperative pathway. Methods: An institutional ethnographic design was used, involving structured and unstructured observations, focus groups, patient interviews and the International Communications Association’s survey, as research methods. Healthcare professionals of different disciplines were purposively selected from diverse perioperative areas in three, public, metropolitan hospitals. A three-dimensional communication model was used to explore sociocultural and environmental influences on communication, attributes of the communication encounter and outcomes of communication encounters. Data were analysed using an institutional ethnographic approach to uncover the social relations interconnecting healthcare professionals’ work and communication practices. The social relations were traced to identify the institutional relations ruling healthcare professionals’ communication. Findings: Over 350 observation hours, 2 focus groups, 20 interviews and 281 survey responses were collated. Healthcare professionals’ communication patterns revealed communication was frequently face-to-face, short in duration and interrupted. Constant information relay was evident as healthcare professionals engaged in patterns of conveying and exchanging information within disciplines, across disciplines, and across domains of the perioperative pathway. Communication failure occurred due to a lack of open communication among healthcare professionals, as a result of difficultly in distributing information and of healthcare professionals adapting work processes to streamline their work. Furthermore, the odds of communication failure happening were higher when overlapping communication occurred and when post anaesthetic care nurses engaged in multitasking while communicating. Frequent consequences of communication failure were associated with: increased communication interactions, missing information conveyed in communication encounters and increased workload. Compromised patient safety and a reduction in the quality of patients’ care were also outcomes of communication failure. Healthcare professionals exhibited many communication successes as they applied a range of compensatory strategies to forestall communication failure. These strategies overcame discontinuities in communication to prevent patient harm. Healthcare professionals were observed to anticipate, detect and compensate for information loss in communication. Implications: To foster open and accurate communication a reduction in time pressures could ease asynchronous workflows, increase time for documentation, lessen the need for multitasking while communicating, and diminish overlapping communication. Additionally, to encourage information sharing, interdisciplinary education could provide understandings into healthcare professionals’ roles and information needs, and balance unequal power relationships. Furthermore, direct and timely communication could be promoted by technology systems that facilitate information distribution, and support direct communication among healthcare professionals.